Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

Abstract

Aim: The aim of this study was to investigate the implication of clinical findings of vascular injury and routinely employing angiography in patients who sustained a gunshot to the neck. Patients and Methods: We retrospectively studied the demographics, bullet tract, clinical findings, diagnostic investigations, methods of treatment, outcome, and time in hospital of 70 patients who sustained a gunshot to the neck and who all underwent angiography. Results: In nine cases angiography revealed lesions to the common carotid artery (four patients), internal carotid artery (three patients), vertebral artery (one patient), and lingual artery (one patient). Physical examination had already indicated vascular damage in seven of these patients with findings such as expanding hematoma (four patients), absent carotid pulsations (two patients), bruit (one patient), and hypovolemic shock (one patient). Subsequently, these seven patients were treated operatively by performing elective neck exploration. Of these seven patients who underwent surgical repair, vascular damage was already suspected based on physical examination. The two patients with injury on angiography without clinical evidence did not deteriorate on conservative management. Conclusions: Careful clinical assessment proves to be a useful instrument in determining the necessity of surgical exploration. In our experience in 70 patients, the results of angiography did not alter the management of the patients who sustained a gunshot to the neck.Our results on conservative management with selective angiography indicate that morbidity and mortality of unnecessary neck explorations are avoided without increased risk.

Multiple-Projectile Penetrating Neck Injury from a Modified Nail-Containing Gas Pistol

“…Injuries were to the upper airway, spine and nerve roots in Zone II and III and the patient was haemodynamically stable. Up to 80% of such cases may be treated conservatively (1). A foreign body in a region of the upper airway prone to posttraumatic stenosis warranted an active attitude in this case.…”

Gunshot Wound to the Atlantoaxial Spine Associated with Vertebral Artery Occlusive Injury

“…[1][2][3][4] When the patient survives, usually it is due to a low velocity bullet combined with a peculiar trajectory dissipating the kinetic energy and heat to the paravertebral soft tissues and vertebrae, not affecting the major structures as the spinal cord and vessels. 1,[9][10][11][12] Careful investigation is required, given that the management of these patients will depend on the clinical presentation, the location, and damage extension to the atlantoaxial complex. Plain radiography shows the probable projectile trajectory, bone and metal fragments.…”

“…Concomitant vascular injuries should be investigated with angiography or a high-resolution CT angiography. 9 Usually, vertebral artery injury is rare considering it is protected by bone. 13 A major penetrating trauma, though, can affect the vertebral artery directly, usually causing hemorrhage or indirectly leading to acute or delayed hematoma, pseudo aneurysm, arteriovenous fistula (AVF), or vascular occlusion.…”

Vertebrojugular arterio-venous fistula and psudo-aneurism formation due to penetrating vertebral artery injury: case report and review of the literature

“…Emergent exploration was preferred for patients with firearm injury before the 90's but more detailed radiological examination is required these days. Eighty-percent of cervical firearm injury patients are believed to be eligible for conservative treatment and close follow-up (6,32). Management of VAI due to cervical spinal trauma is still controversial.…”